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Ask the Mental Health Expert Archives 2001-2004

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Dialectical Behavioral Therapy

Q. I am a family advocate and am about to start a case where the therapist suggests Dialectical Behavioral Therapy. I am unfamiliar with DBT and have been scouring the web trying to come up with a clue. Marsha Linehan's book came highly recommended, but it is not at the library nor at the two book stores near me.

A. Dialectical Behavioral Therapy (DBT) is a modified form of cognitive-behavioral therapy (CBT), developed initially by Dr. Marsha Linehan. DBT has been extensively used to treat Borderline Personality Disorder and related conditions.

To quote from an excellent recent review by Swenson et al (Psychiatric Quarterly 2001; 72:307-24), "at its core, [DBT] balances a relentless insistence on problem solving, informed by behavioral principles and techniques, with an attitude of acceptance embodied in validation, empathy, and a radical acceptance of things as they are 'in the moment'...the therapist provides a validating environment, extinguishes maladaptive behaviors, teaches skills to help with emotions and relationships, and ensures that skills are reinforced... [and]...generalized to all relevant environments."

In short, DBT combines empathy with behavioral modification and self-discipline in the right amounts--perhaps not so different than most forms of successful psychotherapy. You will gain a good understanding of DBT by reviewing this paper, but there is no substitute for working with someone who has been trained in the technique. For more information, you can contact Dr. Swenson at crobert01@aol.com.

February, 2002

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